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Scott Barb, Avni Patel, Tomasz Stryjewski, Christopher Andreoli, Matthew Gardiner, Simmons Lessell; Characteristics and outcomes of open globe injuries with clinical optic neuropathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6037.
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There is limited published data regarding optic neuropathy in patients with open globe injury. We performed a retrospective chart review of an open globe database to improve our understanding of the characteristics and outcomes of those with clinical optic neuropathy. We hypothesize that the typical mechanism of injury will limit the number of cases of optic neuropathy but that analysis will provide an interesting comparison of those with and without optic neuropathy.
We analyzed data from a large institutional database (Massachusetts Eye and Ear Infirmary Trauma Database) over thirteen years (1999-2012). Patients with open globe injury were included for analysis. Clinical optic neuropathy was determined based on the appearance of the optic nerve head and the presence of an afferent pupillary defect (APD). Statistical analyses (a combination of t-test, chi-square, and Fisher's exact test) were performed to determine if there were clinical and outcome differences between those with and without clinical optic neuropathy.
Of the 893 patients with open globe injury, 13 (1.46%) patients were determined to have clinical optic neuropathy. There was no difference between the age and sex of our two groups (p= 0.83, 0.626). The presence of APD was more common in those with optic neuropathy (p=0.002). There was no difference in the incidence of vitreous hemorrhage, intraocular foreign body, or orbital fracture (p=0.068, 0.428, 0.555). The appearance of stretching of the optic nerve on CT did not predict optic neuropathy (p=0.322). There was no difference between the presenting and best visual acuity (p=0.12, 0.06). However, there was a difference in regards to the incidence of retinal detachment development (p=0.013).
The incidence of optic nerve damage in the setting of open globe injury is low as we hypothesized and thus evaluation from a large patient cohort is necessary to determine the significance of characteristics and outcomes in those with and without clinical optic neuropathy. Of the evaluated clinical characteristics, only the presence of an APD could predict the increased likelihood of clinical optic neuropathy. It is surprising that there is no difference between the presenting and best visual acuities in those with and without optic neuropathy. However, it is likely that significant damage to other vital structures such as the cornea and retina limit the visual potential.
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